Some Benefit Seen for Abstinence-Only Sex Ed

by John Gever John Gever Senior Editor, MedPage Today
February 01, 2010

Action Points

Explain to interested patients that abstinence-only education has been advocated by some as the best approach to discouraging teens from having sex, but previous studies have found that it does not reduce pregnancies or risky sexual behaviors.

Explain that this was a randomized trial of several different interventions including an abstinence-only program, a relatively strong form of evidence. Explain, too, that while a statistically significant benefit was seen for the abstinence-only program, the size of the benefits were modest.

An education program for middle-schoolers promoting chastity significantly reduced their self-reported sexual activity two years later, compared with other sex education approaches, researchers conducting a randomized trial said.

The number of adolescents reporting they had lost their virginity was cut by one-third with an abstinence-only program delivered in sixth and seventh grade, according to John B. Jemmott III, PhD, of the University of Pennsylvania, and colleagues in the February Archives of Pediatric and Adolescent Medicine.

The proportion of teens receiving the abstinence-only program who reported they had had intercourse at least once was 32.6%, compared with 41% to 52% among participants assigned to other interventions. These included comprehensive education covering both abstinence and methods to prevent pregnancy and sexually transmitted diseases (STDs), as well as a program focusing on "safer sex."

Although the reliance on participants' self-reports of sexual behavior was a significant limitation, Jemmott and colleagues cautioned, they called the results "promising."

"They suggest that theory-based abstinence-only interventions can have positive effects on adolescents' sexual involvement," they wrote. "This is important because abstinence is the only approach that is acceptable in some communities and settings in both the U.S. and other countries."

Jemmott and colleagues indicated that the abstinence-only program used in the study was unusual. In fact, it would not have qualified for abstinence-only federal funding because it did not rely on moral principles, nor did it criticize condom usage.

But its benefits in the study appeared limited to delaying sexual initiation, with no reductions in risky behaviors such as unprotected sex and having multiple partners.

In an accompanying editorial, two other researchers warned against interpreting the study to justify policies to promote abstinence-only education.

"No public policy should be based on the results of one study, nor should policy makers selectively use scientific literature to formulate a policy that meets preconceived ideologies," wrote Frederick Rivara, MD, MPH, of the University of Washington in Seattle, and Alain Joffe, MD, MPH, of the Johns Hopkins University.

Rather, they urged, the new study's results must be combined with earlier research to "become part of the knowledge base for the formation of public policy on sexuality education."

Jemmott and colleagues tested five different programs on 662 African-American sixth- and seventh-graders in four schools in low-income areas of a northeastern U.S. city.

The programs included:

Eight hours of abstinence-only education addressing risks of HIV and other STDs as well as pregnancy, seeking to promote waiting to engage in oral, anal, and vaginal intercourse "until later in life when the adolescent is more prepared to handle the consequences of sex"

Eight hours of safer-sex instruction, encouraging condom use but not sexual abstinence

Eight hours of comprehensive education combining support for abstinence as well as safer-sex content

Each of these were delivered in one-hour modules over two weekend sessions, except for the 12-hour comprehensive program that was given in three sessions.

In addition, half the participants in each program were randomly selected to receive "booster" education, including three-hour sessions given six weeks and three months after the initial program, six issues of a newsletter, and six 20-minute individual counseling sessions with the original instructors over a 21-month period.

The children were quizzed about their sexual behaviors at baseline and five more times for two years after the initial intervention.

Although the abstinence-only program appeared more effective in delaying sexual initiation, it had little or no effect on other sexual behaviors including multiple sex partners, engaging in unprotected sex, and consistency in condom use.

After adjusting for covariates, Jemmott and colleagues found the following relative risks at the two-year point in the abstinence-only group for engaging in sexual behaviors, relative to the teens who only received the general health promotion program:

None of the other sex education programs showed any advantage over the general health promotion instruction in any outcome, with one exception: the 12-hour comprehensive intervention slightly reduced the risk of having multiple sex partners (RR 0.95, 95% CI 0.91 to 0.99).

The booster education had little effect on outcomes, Jemmott and colleagues indicated.

It did not affect the effectiveness of any program in reducing sexual initiation, recent intercourse, or unprotected sex, they found.

The researchers did find some benefit for the follow-up education in decreasing the incidence of multiple-sex partners following the abstinence-only and 12-hour comprehensive programs.

Even so, however, the relative risks in both groups for having multiple partners were still higher than 0.90 compared with the general health promotion control even among those who received the follow-up education.

Jemmott and colleagues said the findings could help dispel one criticism of abstinence-only education, which is that it may discourage condom use among teens who choose to have sex anyway. Although their study found no improvement in condom usage among those in the abstinence-only group, it also showed no reduction, they pointed out.

In addition to relying on participants' self-reports for the outcome measures, limitations of the study included small numbers of sexually active teens in the sample, and the focus on urban African-American middle schoolers.

"Whether the results would be similar with older adolescents or those of other races or in other countries is unclear," the researchers wrote.

The study was funded by the National Institute of Mental Health.

No potential conflicts of interest were reported by study authors or editorialists.

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